CRF question

bbairdSeptember 17, 2010

Sorry. I'm so tired, I put the wrong title. I was afraid if I didn't post the correct one, experienced people might not respond...(how do I delete my other post?)

I know this is difficult for someone to answer without knowing the cat or specific circumstances, but, I need some feedback.

I know a lot of this is a rehash, as I've posted about my situation a lot lately, but...

I give my cat 100ml of fluids each day. She's been on fluids for 1 year; she also has cancer.

The past few days, she's been sleeping more and more. Today, she slept under the blanket all day, just to come out to drink a little, eat a little, pee a little. She seemed distracted and agitated at times.

She still purrs when I pet and kiss her. She even inspected a box I had brought home. She climbed on the couch to inspect it, then went back under her blanket. One minute she seems to be at death's door; the next minute she seems fine. I'm so emotionally exhausted from this past year. (This is on top of many other things that have been going on--blech--life is cyclical) You know how you analyze every move they make when they're sick.

I gave her the day off from fluids today because I don't see the point in stressing her when she seems to be nearing the end.

The question is, has anyone else dealt with this? When do you stop giving her fluids and just let her be? Will this cause her pain?

NO. I'm not going to euthanize her. She doesn't appear to be in pain. If, and when, she seems to be so, I have a vet who will come to my home to do it. I don't believe in killing my cat for my convenience--only if she's in pain.

Sorry that this is so long.


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For an animal, "distracted and agitated" can well mean they're in pain. They don't have to be vocal about it unless it's acutely out of control, but will endure and hide (under the cover if that's what's available). And cutting off fluids is a bad idea because she can lose kidney function, even for a day if she's otherwise sick. You don't believe in euthanasia for your convenience? What about keeping her going for your convenience? Emerging from her 'lair' to check out a box (old habit) does not mean she has any quality of life left.

    Bookmark   September 17, 2010 at 5:15AM
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I'm not keeping her going for my convenience.

I don't know what's happening. That's why I'm asking for input.

If I had euthanized her every time I was told to by vets and posters, she would have been dead many, many months ago. Up until a few days ago, she was a fairly active and very happy cat.

I don't just want to pull the plug on her if this isn't the end.

My ONLY concern is doing the best for HER.

    Bookmark   September 17, 2010 at 5:45AM
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Maybe I worded it incorrectly.

"I don't believe in killing my cat for my convenience--only if she's in pain."

I mean that, if she's in pain, THEN I will do what I have to to end that pain for her.

    Bookmark   September 17, 2010 at 5:48AM
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And how do you expect that she will show you pain?

    Bookmark   September 17, 2010 at 7:25AM
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Well, I will share some of my experience with you and hope that it helps some. I am not in a good frame of mind this morning, so forgive me if this is choppy.

I've been dealing with a CRF cat for 4.5 years. I hear ya on tired and frustrated! My experience has been that the ups and downs happen frequently. More than once I've looked at my kitty and thought, "This is it." From time to time she will be "off" for a few days at a time. Three years ago in October she went under the bed for 2 days and did not want to come out. She looked so sorry that I didn't give her fluids, and couldn't bring myself to give her her thyroid meds (bad, I know, but it was a call in the moment). I was surprised when she just bounced back about the time we got in to see the vet. That was the point I stopped focusing so much on doing everything medically right, and just started doing what was right for her day to day. If she wanted to eat "junk food" because it was all that would go down and stay down, so be it.

How are your temperatures where you live? My cat does much worse in cooler weather. She is antsy and uncomfortable when the temperature of the house gets under 70F. She will huddle up under blankets, or act agitated and only calm down if she is held or cuddled. Given she is quite thin, I suspect she is incapable of staying very warm on her own. I tried to give her a heated bed, but for whatever reason, she does not like it.

I understand that your situation is a bit different because of the cancer. My little boy buddy cat passed away from cancer in 09. He did not have CRF, but with the blessing of the vet, we gave him fluids the last couple weeks of his life to prevent him from getting dehydrated until he told us he was ready. One day the fluids were helping him to still enjoy some quality of life, and the next day I felt like I was giving him fluids only to prolong the inevitable--- it is just something you know when you love them. But along those same lines, he was getting so dehydrated without fluids that I would not have just stopped them and let him be. Do you know how to test your cat for dehydration by pulling up the skin on her neck?

I'm so sorry, I know there are no easy answers. This is a day by day thing. Do what is right for today to give her some enjoyment and quality of life- whether it is a certain food, or some extra warmth, or a birdfeeder by the window, or her fluids. Then start with a clean slate tomorrow and decide how her quality of life is, and what you can do to make it a good day. I wish you all the best, it is so very difficult.


    Bookmark   September 17, 2010 at 10:58AM
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The most difficult aspect of managing a chronically ill animal, esp. a cat in CRF, is dealing with the physical roller coaster they often experience with this disease. As quasifish noted, CRF cats do tend to have good and bad days, weeks, or other periods of time, and it's extremely difficult to figure out when those bad days are no longer going to turn around into good days again. We keep hoping for one more rally, but inevitably there comes a time when no more rallies will happen. At that point, the only humane option is euthanasia. I reached that point with my Beloved Billy a few months ago, about 2.5 yrs after diagnosis with CRF and hyperT.

bbaird, it may be that your girl is finally succumbing to her illnesses, or it may be that she has another rally up her kitty sleeve. You are the only one who knows her well enough to assess when the difficulties of her conditions overwhelm the benefits of maintaining her life. That said, I would NOT recommend withholding fluids from her, even if they make her a little uncomfortable (I hope you've started warming the fluids for her). I've seen firsthand how extremely ill dehydration can make them feel, and a CRF cat who has been dependent on fluids for a year will dehydrate quickly without them. Trust me, you don't want her to go through that. The only time I would withhold fluids, aside from medically necessary circumstances like congestive heart failure, would be within 24 hrs of euthanasia.

Keep her hydrated. It's the most important thing you can do for her medically as long as she's still with you.


    Bookmark   September 17, 2010 at 7:46PM
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I haven't read whatever else you've posted other than this one so not sure what the rest of the story may be but I'll share my situation in case it's of any help in deciding what to do. I had a cat with CRF who lived on for two years after the diagnosis - so two years of subQ fluids and various complications and an emotional roller coaster for me. Many times I thought it was the end but it wasn't. I will say my cat had a lot of ups and downs and he spent a lot of his last two years sleeping under the covers. DH and I talked many times about how will we know when it's time and he always said you'll just know. I had to coax him to eat many times, slip various meds into him in creative ways, keep the fluids going every day, etc. Toward the end he had three episodes of seizures (that I was around for) and I really questioned whether I was prolonging his life and possibly suffering for my sake or his. The last seizure was the worst and I really thought he was dying - that it was the end - and I was okay with it because I could hold him and send him off. Nope- he came out of that and continued on. I thought he was enjoying life some because he still went out on our porch and slept on the couch -even when it was kind of cool out there. I started covering him up with a blanket. Otherwise he slept on our bed. In his final days he was losing more and more weight and not particularly interested in eating. He really wasn't getting up to use the litter box - I was taking him there. I work during the day so I just couldn't be with him all the time. I came home one day to find him right where I left him on the bed in the morning which had never happened before. He was all wet sitting in the comforter soaked with urine. He had a sorrowful look on his face and that was when I knew it was time. I just knew he did not want to live like that. It was very hard to make a decision to euthanize him but I would certainly make that choice over withholding fluids and what may be a slow and painful death as a result of that. The only time I did that was as mentioned above - when I knew the end was imminent.

    Bookmark   September 18, 2010 at 11:01AM
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quasifish, laurief, gibby3000,

Thank you for answering my questions without judgment, just compassionate advice.

I tried warming the fluids for a few months, but, it never seemed to get very warm -- I tried everything from soaking in hot water to putting it in a heating pad for half an hour. I'll try again.

Yes, the weather's changed here. It's much cooler.

Yesterday was horrible. After a day off (Thursday), I gave her fluids in the morning (Friday). After about half an hour, she became very agitated and distracted. She spent the next 5 hours moving around the apartment going from one surface to another (she yowled twice during that time) unable to settle. She was very distracted and agitated.

She quieted down, finally, and slept for a few hours. She's been eating and drinking and using the litterbox since.

As you all noted, it's a day-to-day deal. I try to weigh the good days vs the bad. This was the first and only time that she exhibited this behavior. As I noted, until yesterday, she's been a pretty cheerful little girl--even when she's been much less active.

Most days, she has 5-10 bad minutes (getting fluids and vomiting after defecating) and 23 hours and 50 minutes of good minutes.

I'm sorry you all had to go through this, too.

    Bookmark   September 18, 2010 at 4:40PM
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I'm sure we're all very sorry that you and your girl have to go through it, too. There's nothing easy about it, though there is something to be said for the intense bonding that can result from caring for a chronically ill animal.

I may be way off the mark here, but from your description of yesterday's events, I am wondering if her agitation after fluids was the result of the room temp fluids chilling her badly. That's why vets administer room temp fluids to cats with high fevers, you know - to help chill their bodies and bring down the fever. I assume that your girl is probably quite thin right now, which, coupled with her illnesses, makes it much more difficult for her to maintain a comfortable body temp when the air is chilly. Room temp fluids are likely to be extremely uncomfortable for her.

Here's how I warmed fluids for Billy. I put the fluid bag and most of the line into a sink of very hot water, being careful to keep enough of the line on the counter so that I could put something heavy (like a bottle of lotion) on it to prevent the connection of bag to line from sinking into the water (that connection must be kept dry). I left the bag in the sink until the water cooled enough so that I could comfortably dip and hold my wrist in it. The amount of time that took depended on how much fluid was in the bag. When the sink water was comfortably warm on my wrist, the fluid in the bag was comfortable for Billy.

If you are not certain whether the fluid might be too warm, it's best to err on the side of a little too cool rather than any too warm.

Give it a try again. Once you get those fluids warmed up properly, I bet your girl will be a lot happier with the admin and its after effects.


    Bookmark   September 18, 2010 at 5:48PM
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I think you were absoluetely right about the fluids being too cold the day she was distressed.

Thank you for urging me to try warming the fluids again. Although she still dislikes getting them, that hasn't happened again and she (barely) tolerates getting the fluids. Because I switched from 18 to 20 needles, she loses patience halfway through, but, she runs to her wheatgrass for solace (as she always did) right after the fluids.

I can't thank you enough.

She's still not great, but, much better -- 2 steps backwards, 1 step forward. That's how it's been the past 6 months or so.

    Bookmark   September 22, 2010 at 11:46PM
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I'm so glad that warming the fluids has made things easier on the two of you. That was a lesson I learned at the expense of my first CRF cat, Pea. The vet who taught me to administer fluids didn't mention anything about warming them, so I had no idea that room temp fluids could be so chilling and uncomfortable for a cat. Pea would growl and fight while receiving her room temp luids until I called the vet's office and spoke to one of the techs. SHE was the one who told me to warm the fluids. As soon as I started doing that, Pea stopped growling and fighting. She never actually enjoyed receiving fluids, but, like Billy, she made the connection between receiving the warmed fluids and feeling much better overall.

One more suggestion for you - If those needles you're using aren't Terumo Ultra Thin Wall needles, I recommend you switch to them. The 20 ga Terumo UTW needles have about the same flow rate as regular 18 ga needles, so you should be able to get fluids into your girl before she gets too impatient.

Hang in there!


    Bookmark   September 23, 2010 at 10:41AM
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I have one more suggestion regarding fluid administration. If you're not already doing so, give the fluid admin in the morning after your girl has eaten breakfast. She will be more comfortable after she's eaten, and by giving her fluids early in the day, she'll learn that she has the rest of the day to relax with no more unpleasant procedures. This worked very well with Billy. He'd avoid me for a few minutes right after the admin, but then we'd have a very pleasant, relaxed day together. Much better than having him spend the whole day anticipating getting stuck with a needle.


    Bookmark   September 23, 2010 at 6:01PM
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These are 20g Terumo UTW Needles -- they still do take twice as long as the 18g Terumo. I've upped the amount from 75 to 100ml, so that would account for a 1/4 increase in time, but, I swear, it goes soooooo slowly -- even the days I do only 75 ml (when my cat's had enough, I let it be).

Also, I'd been doing fluids in the morning up until about a week or 2 ago. I work the graveyard shift a couple of nights a week, then switch back to 12-16 hour days (11am until night) on weekends. Whether I came home at 8am, 10pm, or 3am, I'd get up at (or stay up until) 9am to give her fluids. This is part of what's so exhausting. And, since, at this point, she sleeps an awful lot, I decided to give her fluids at night since it takes 1-2 hours to heat up the fluids and then let them cool down to the right temperature.

Also, she's a free-feeder, so, there really is no breakfast/lunch/dinner.

Whew! Sorry for the long explanation.

    Bookmark   September 23, 2010 at 11:23PM
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Slow fluids - Try relocating the tip of the needle under the skin and/or rotating the tip by rolling the hub between your fingers and/or partially withdrawing the needle while the fluids are running. I found that by doing any or all of those things when fluids ran slowly with Billy, I could find a spot or an orientation or a needle depth that would make fluids run much more quickly. Oh, also try tenting the skin above the needle after insertion. Sometimes that REALLY gets the fluid flowing fast.

Sometimes if you give fluids in the same spot for too long, that spot will develop some scar tissue that causes fluids to distribute much more slowly. Also, sometimes that scarring can cause additional discomfort for the cat. That happened with Billy, too. I got in the habit of orienting the needle so that it pointed slightly down over his left shoulder. I gave fluids in this location for over a year with no particular complaint from Billy. Then all of a sudden he started growling and struggling during admins for a couple of days in a row, so I switched the needle position to allow the fluids to disperse over his right shoulder, instead. Problem solved. Growling and struggling ceased AND fluids flowed more quickly in the new location.

Warming fluids - this should NOT take 1-2 hrs. I suspect you are using too large a sink filled with too much water that is too hot. Use a smaller bathroom sink and fill it only enough to mostly cover the fluid bag. The bag doesn't even need to be entirely submerged. The water in the sink doesn't need to be superheated, either. It just needs to be hot enough to be pretty doggone uncomfortable on your wrist. As long as the bag remains in the sink for at least 15 mins before the sink water cools too much, the fluid wiill warm properly. To make sure the fluids are evenly warm in the bag after you remove it from the sink, rock the bag gently back and forth a few times right before admin.


    Bookmark   September 24, 2010 at 10:27AM
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